晚期非小细胞肺癌伴梭形细胞和/或巨细胞癌患者的真实世界治疗模式及预后
Real-world treatment patterns and outcomes among patients with advanced non-small-cell lung cancer with spindle cell and/or giant cell carcinoma.
作者信息
Chang Chia-Ling, Hsieh Min-Shu, Shih Jin-Yuan, Lee Yi-Hsuan, Liao Wei-Yu, Hsu Chia-Lin, Yang Ching-Yao, Chen Kuan-Yu, Lee Jih-Hsiang, Ho Chao-Chi, Tsai Tzu-Hsiu, Yang James Chih-Hsin, Yu Chong-Jen
机构信息
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, and National Taiwan University College of Medicine.
Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.
出版信息
Ther Adv Med Oncol. 2022 Oct 27;14:17588359221133889. doi: 10.1177/17588359221133889. eCollection 2022.
OBJECTIVES
A definitive diagnosis of pulmonary sarcomatoid carcinoma cannot be made with small biopsies. In clinical practice, a diagnosis of advanced non-small-cell lung cancer with spindle cell and/or giant cell carcinoma (NSCLCsg), or possible sarcomatoid carcinoma, is acceptable. Therefore, we aimed to investigate the treatment patterns and outcomes of advanced NSCLCsg.
MATERIALS AND METHODS
Between 01 January 2012 and 01 April 2021, patients with pathologically proven advanced NSCLCsg were enrolled. The choice of treatment was based on clinician discretion.
RESULTS
In all, 101 patients with advanced NSCLCsg were enrolled. In total, 77 (76.2%) patients received at least one line of systemic therapy; 44 patients (43.1%) had received platinum doublet chemotherapy; 27 (26.7%) patients had been treated with targeted therapies; and 23 patients (22.8%) had been given an immune checkpoint inhibitor (ICI). The median overall survival (OS) was 6.3 months [95% confidence interval (CI): 3.6-9.0 months]. Excluding patients without systemic therapy, patients who had received an ICI had better OS (median: 18.2 months) than those who had not (median 3.8 months, log-rank test = 0.002). No significant difference in OS was detected between patients who had or had not received platinum doublet chemotherapy (log-rank test = 0.279), or targeted therapy (log-rank test = 0.416). Having received any systemic therapy [hazard ratio (HR): 0.33, 95% CI: 0.18-0.61, < 0.0001) and ICI (HR: 0.38, 95% CI: 0.19-0.78, = 0.008) were independent factors for better OS. Patients with programmed death ligand-1 (PD-L1) expression ⩾50% had better OS than those with PD-L1 expression <50% (HR: 0.51, 95%: 0.30-0.86, = 0.012).
CONCLUSION
Although advanced NSCLCsg has a poor survival outcome, our results showed that ICI may prolong OS in patients with advanced NSCLCsg. Further prospective studies are warranted to gain more understanding of the role of ICI in this specific patient population.
目的
小活检无法对肺肉瘤样癌做出明确诊断。在临床实践中，诊断为晚期非小细胞肺癌伴梭形细胞和/或巨细胞癌（NSCLCsg）或可能的肉瘤样癌是可以接受的。因此，我们旨在研究晚期NSCLCsg的治疗模式和结局。
材料与方法
2012年1月1日至2021年4月1日期间，纳入经病理证实的晚期NSCLCsg患者。治疗方案由临床医生酌情选择。
结果
共纳入101例晚期NSCLCsg患者。总计77例（76.2%）患者接受了至少一线全身治疗；44例（43.1%）患者接受了铂类双联化疗；27例（26.7%）患者接受了靶向治疗；23例（22.8%）患者接受了免疫检查点抑制剂（ICI）治疗。中位总生存期（OS）为6.3个月[95%置信区间（CI）：3.6 - 9.0个月]。排除未接受全身治疗的患者后，接受ICI治疗的患者OS较好（中位值：18.2个月），而未接受ICI治疗的患者OS较差（中位值3.8个月，对数秩检验P = 0.002）。接受或未接受铂类双联化疗的患者之间OS无显著差异（对数秩检验P = 0.279），接受或未接受靶向治疗的患者之间OS也无显著差异（对数秩检验P = 0.416）。接受任何全身治疗[风险比（HR）：0.33，95%CI：0.18 - 0.61，P < 0.0001]和ICI（HR：0.38，95%CI：0.19 - 0.78，P = 0.008）是OS较好的独立因素。程序性死亡配体-1（PD-L1）表达≥50% 的患者OS优于PD-L1表达<50% 的患者（HR：0.51，95%：0.30 - 0.86，P = 0.012）。
结论
尽管晚期NSCLCsg的生存结局较差，但我们的结果表明ICI可能延长晚期NSCLCsg患者的OS。有必要进行进一步的前瞻性研究，以更深入了解ICI在这一特定患者群体中的作用。
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